HomeMy WebLinkAbout40894-Z �Su�ot� TOWN OF SOUTHOLD
�� �'��,� � BUILDING DEPARTMENT
� � TOWN CLERK'S OFFICE
' o • � SOUTHOLD, IVY
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BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
� WITH OiVE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 40894 Date: 8/9/2016
Permission is hereby granted to:
Elliot, Nancy
2200 Harbor Ln
Cutchogue, NY 11935
To: demolish an existing swimming �aool as applied for.
At premises located at:
2200 Harbor Ln, Cutchogue
SCTM # 473889
Sec/Block/Lot# 103.-1-27
Pursuant to application dated 8/3/2016 and approved by the Building Inspector.
To expire on 2/8/2018.
Fees:
DEMOLITION $100.00
Total: $100.00
f
,
' g Inspector
. , �
TO;WN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING D�PARTMENT - � , � � •.. �� - ` f� , ��:=Do.yoit�have or need the:following,�before applying?
TOWN HALL �B�ard�of L-iealth�,, ' t��: �
SOUTI�OLD,NY 11971 �- • � 4 sets of Building Plans
TEL: (631) 765-1802 ., . _ ._ . , ;Pianning:B'oard�approval :� ��_. �"
FAX: (631) 765-9502 ' I �� , / Survey
SoutholdTow�:No'rthFork.net PFI�MIT NO. '�"�C�.`7:�(' " .t� . _.'Check �'•fr 'i ��� . , �� �
_ � . . , .: ' , ,-�{-„ ,'� ;� ` Septic Form
- . . ` N.Y.S.D.E.C. . �
Trustees
- - ` - • - � Flood Permit --- ' �� ,_ i
Examined� " • ' ,20 '� �°-�� '" `' ' f Storm-Water Assessment Form
_ .' �. , , �� , ,r ,�,f,, � � , . -, ' _ �_ Contact: ;�As�:"_;.;. ; , _ . �•t . . . � ,
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Approved ,20 ��� " �� �` � �� �Mail to: � ��
Disapproved a/c . . . � ;- , ;s: ,. -. . ,, , �: �� .. ,� �:>� . 3 • +• � �._
Phone:�,.�J— 7[��—��o�,b
Expiration ., ,20 . ' - . .♦ , � '; " ` ,. . ,` r' � • • ' �'� � �
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APPLICATION FOR�UILDING PEI�MIT
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. . - - - �-- .- : _ . � . , ..:�� Date w t .3, -,•20�
BUILDIlIIG DEpT. INSTRUCTIONS
TO@VN OF 50UTHAI.D . - . . . � '� _ . _ . _. � , ,x ' . �
a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
sets of plans, accurate plot plan to scale. Fee according to sct�edule. -,,,�, ; ,- • , �, •. - � �
b. Plot plan showing Iocation of lot and of buildings on premises,relationship to adjoining premises or public streets or
areas, and waterways. , , , , .
a The work covered by this applicatiori�may not`be coinmeri�ed�before issuance of BuildingPPermit.� � � � � �
d. Upon approval of this application,the Building Inspector will issue.a Building Permit to the applicant. Such a permit, ,
shall be kept on the premises available for irispection'througho'ut�the work: �`'' `fi � ' :: .`. ��� �. �� �. ' .. '�', ' � '
e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector
issues a Certificate of Occupancy: ' �s� ''� . ." �. �'`- ''`_ � . .� . � . � r ._ `` _ ' ' � ' ' . .- " ' � , . � °. ' ,
f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of � �
issuance or has not been compl�tecl'within._18 months from.such"d`ate:If no zoning amendments�or dther i�egulations'affecting'the
properiy have been_enacted in the:iriterim the Building Inspector�anay authorize in writing,_the extension oftheiperrriitfor,an
__ �., �_ _�_ _. �_ � .._..._._
addition six months. Thereafter,,a new permit shall be required:<< -,;_,�, �,,�, '�t -, �� s� `
APPLICATION IS HEREBY�IVIADE to the Building Department for�the issuance'of a Building�Permit pursuant to the
Building Zone Ordinance,of the Town of SoutholdJ Suffolk,County,.Neu�PYork, and;other applicable�Laws, Ordinances.or r ; .
Regulations, for the constructio,n�of buildings, additions, or-alter-ations or for remoyal;or;demolition-as herein described.,The
applicant agrees to comply with all applicable laws„ordinances,�building code,�housing-code,.a�d regulations, and to admit�
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authorized inspectors on premises and in building for necessary uispections., ,� � ` '
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State whethe�ap����an�i§�aPwnex;Lessee���agent, architect, engineer, general contractor, el'e`ctrician;�plumber or build'e'r
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If applicant is a cor�'��S att�o�,rsg'si i�atura��rd��l���it1�C��zecl of'ficer' ` �,,, �,�.f;-i't-q ¢', ��:-�' - F ��� , , .- ,
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Plumbers I,icenae No. � , ,1�; .s1: x�: t,.i,+; !j,-, ;r,? .r,�°,��""`;:� : . ,,�.'.i� � � �'��, ,.�� < , �, ,
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1. Location of land o which proposed work will be done: �°P"`"`�s� . .' ' , . ' ` ,, , l
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� House'Number Street , -Hamlet � � ." ' ` , � �
Ii �/ E�: iv}}t�f�. ' ' ' ; , 5 ". _ � tr� C. �� `` '� � '�
County Tax Map No. �1000 Section " � �� Block ( � LotJ
Subdivision ' Filed Map No. Lot
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�( 2. , .State existing use and occupancy,of:premises and intended use and occupanc� of prQposed construcfion: w -:z: •��� �
a. Existing use and oecupancy /�,�m�dAZ v� F�on G,
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b. Intended use�and occupancy � � �
"�C 3. Nature of work (check which�applicable)^:_New Building � ` kAd"dition > � ,a� ��� z Alteration'` ' � � �
Repair Removal`�="w d Demolition Other Work
�� `• ' ` � (Description)
4. Estimated Cost ` �` "'�' Fee
- - , , ,, ,, � , .� (To be paid on�f ling this application) ,
5. If dwelling, number of dwelling .units Number of dwelling units on each floor
If garage, number of cars � � � �� �
6. If business,commercial or mixed occupancy, specify nature and extent of each type of use. � �
7. Dimensions of existing structures, if any: Front Rear Depth"
Height Number of Stories ��������;�� `°.,��
� ��� � ��� ��
Dimensions of same structure with alteratio'ns•or additions:�Front Rear � � ,
Depth Height Number of S T s r . �..�i�..�
- ' , '1 " I p, -: tc. 1 ., n . . , �i i:'� ... ���6 F'�
8. Dimensions of entire new construction: Front Rear Depth
Height .j Number of Stories ���,F[���a�,a����� ���
,. . � : =� � ��, , ����`�.'����.�.�.�`�i��'�''��""�"
9. Size of lot: Front Rear Depth
. . . . , , . is - , ,, . ,�5 . ' � . � . . . .�! ..' �. �� � , ,._ , ' . ,
10. Date of Purchase Name of Forme'r�0'vvner�'t -� •= ' ' ;, . , . , . , ,
� � � . ,�, :� � ' � � � � '' ' .. a f� . ' . '.
11. Zone or use district in whieh premises are situated ' '
� . .�.�� . � . I�'� . .. ,t � � !` i ., f! . !i, . i �+ ' � � • i
12. Does proposed�construction violate'any�zoriing law,ordiii'ance'or`regulati,ori? YES a NO � � '� , '
�.{. _.�� �t. � - � � . .
, ,� .! .. ' ., r�� •', .r��:; � � 1 ' ,. ,� � ;a,,�� . , , , , � _ �
, 13. Will lot be re-graded? YES �NO Will excess fill be removed from premises?YES , , � :NO � i .
- . . .,. � , �t " _ • ••'.t� • '�:.. . _ ...: ' ., .e .. �3 �ir `{r;i', , ���.-.'1 .-. ' . . ' � .. . , �• _, . .;•r.. , ..
14. Names.of:Owner=ofpremises,,�.��r�.,;<<�ts,�. �:s;t��x,�. �..; 'Address�:.� - .���, .�,:�. � ,,,, �:PhorieNo. ...: �. �
Name ofArchitect �� • ��.;�• �1.44i a{�.•zt. x�� a�;:��::l.jAddress�•s�s��.: ;�:, :��i.<. r :�=�PhoneNo .j �� 1 ��, l� ��
Name of Contractor Address-� ": �"�'3 '� =��:<� • . � ��phone-No.-���' ' " ' �
� . . � ' .� r � ;"�, � { , � , i.fi�1:f: .s. .ii .�ri`%i`.,'3P`r`,. ,. � i ,� . . E . ' i . "` �'t �� l ' J . , i
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15 a. Is this'prope'rty'withiri=l`�00 feet'of�a tidal wetl`arid'or•a fresliwate'r wetl,'and? *YES` ' �'NO ' � "
�
* IF YES;SOUTHOI;D�TO�WN`TRUSTEES'&.D:E''C.P�RIVIITS NIAY E REQLTIRED.' '�`'
{, , .. .,..ynt ._ ,. 1. [rii i '') � 'i ".+l.'1 C tJ � ' t. , s. � . ' , �
b. Is�this property witliiri�300 feet of a tid`al�wetlarid? *�YES NO , , , . ,
t}R . . C •' : ,. ' �� r . . � I � .
* IF YES, D.E.C. PERMITS MAY BE REQUIRED.' �' ���' � � '
16. Provide survey,to scale, with accurate foundation plan and distances to property lines. ,
17. If elevation af any point on property is at 10 feet or below,must provide topographical data on survey.
18. Are there any covenants and restrictions with respect to this property? * YES NO
* IF YES, PROVIDE A COPY. � . � , . , - . �. ,
l� STATE OF NEW YORK) �a �� y�3 �
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COUNTY OF�u��cS`�;�) . ,
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'�j � beirig duly sworn, deposes,and says that(s)he is the applicant
(Name of individual signing contract) above named, " ' � CONNIE D.BUPICH " � '-'
Notery Publ�,3tste�f New Yor�t ,
(S)He is the • -� • No.Of BU618�050 �
(Contractor,Agent, Corporate O�cer, etc.) r;,r�l;,;r�i�qinn E ��" unn'
xP A�arll 14,2��
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file�this�application;
that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be, •
performed in the manner set forth in the application filed therewith.� � r , , . ,
Sworn o before me thi . . , , r
day of 20� . . . , , -� , . ; . ., . .
� �u,��,� ,� " . . __ .
Notary Public igna e ofs pp 'can
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� SURV�Y OF �'ROP�RTlES
I SITU,4TE� GUTGHOGUE
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� SUFFOLk CAUNlY TAX a � + (
1000-103-I-21
IDOO-103-I-28 S I
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� � TOTAL AREA= 26A00 SF OR Ob4 AGRES �F\ • I �� _ -_ I
iAREA TnX LOT 2"i - 14,000 SF pR 0.32 AGRES �SF� SQZO"� �`� ,'.-�Y,1„�`M'.Y+"'..'4 j
I AREA TAX LOT 20 = �400 O SF OR 032 AGRES ����• ����� ��L�������� I
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� � 6 EAST MAIIV STREEI'
� I GRAPNIG SGALE I"= 30' NY.S LIC NO 502UZ I
• , ,— ____ RIVERHEAD,N Y 11901
I�— _ 369-8258 Faz 369-8287 REE1�I-Ip serverW�pROS\02-222pro �
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